Fragility Fractures - Orthopaedic Trauma - Lecture Slides, Slides of Orthopedics

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Fragility Fractures

Prevalence

• More than 34 million Americans suffer from osteoporosis or low bone mass
• 80% are women
• 1 in 2 women over 50 years old
• 1 in 4 men over 50 years old

$14 billion annually

Burden of Disease

• Approximately $38 million daily
• Congestive heart failure costs $8 billion annually
• Asthma costs $9.8 billion annually

Burden of Disease

• 1 out of 4 osteoporotic hip fractures result in long-term nursing home care
• One half of these are unable to walk without assistance
• 24% greater risk of dying within one year

- Fragility Fractures & Osteoporosis -

What’s the link? Fragility fractures Fractures of the distal radius, proximal humerus, vertebrae and proximal femur that result from minimal trauma, such as a fall from a standing height.

• Up to 95% of hospitalized fracture inpatients over 75 years of age, and 80%-90% of fractures in patients between 60 and 74 years of age can be attributed to osteoporosis.

recommended on the basis of good practice standards.!^ Only 23% of hip fracture patients received the care Source: RAND Report

• 40% of postmenopausal women and ~25-33% of men will eventually experience osteoporotic fractures.
• ~20 percent of senior citizens who suffer a hip fracture die within a year
• Risk of mortality is 2.8-4 times greater among hip fracture patients during the first 3 months after the fracture
• Nearly 1 in 5 hip fracture patients ends up in a nursing home within a year

Alarming Fracture Statistics

Source: Surgeon General’s Report, 2004, Jrnl of Bone and Mineral Research

Fractures cost $18 billion/year and expected to increase if action is not taken.

The Costs Continue to Grow

Risk Factors for Osteoporosis

• Female
• Thin or small frame
• Low body weight
• Smoker

Risk Factors for Osteoporosis

• Advanced age
• History of fragility fracture
• Family history- primary relative with osteoporosis or fragility fracture

Risk Factors for Osteoporosis

• Post Menopausal
  • Hormonal imbalances can result in rapid bone loss
  • Women can lose up to 20% of their bone mass in 5-7 years

Risk Factors for Osteoporosis

• Amenorrhea, Anorexia & Bulimia
• Diet low in calcium
• Certain medications
• Low testosterone in men

Risk Factors for Osteoporosis

• Inactive lifestyle
• Excessive alcohol

consumption

Ethnicity & Osteoporosis

• 300,000 African-American women have osteoporosis
• 80-95% of all fractures sustained by African-Americans 64+ are osteoporotic
• African-American women more likely to die from hip fractures than White women

Men & Osteoporosis

• 2 million American men have osteoporosis
• 3 million more are at risk
• 1/3 of male hip fractures related to osteoporosis
• 1/3 of these men will not survive 1 year after fracture

Risk Factors for

Fragility Fractures

• Impaired vision despite correction
• Estrogen deficiency at an early age (<45 yrs)
• Dementia
• Poor health / frailty
• Recent falls
• Lifelong low calcium intake
• Low physical activity

Fractures beget Fractures

• Risk of future fractures increases 1.5- 9.5 fold following initial fracture
• History of fragility fracture is more predictive of future fracture than bone density

Diagnosis: Bone Densitometry

Recommendations for bone density

• Anyone with a fragility fracture
• All women age 65 and older
• Postmenopausal younger than 65 with risk factors
• Men over 50 with risk factors

Goals

• Prevent future fractures
• Treat osteoporosis
• Decrease the risk of mortality after fractures

Treatment

There is a high prevalence of vitamin D insufficiency in:

• Nursing home residents
• Hospitalized patients
• Adults with hip fractures

Treatment

• A man with a hip fracture has a 1:3 chance of dying within a year
• A woman with a hip fracture has a 1:4 chance of dying within a year
• The risk for ONJ among patients taking oral bisphosphonates is likely to be 1:100,

Bisphosphonates

7. Patient Note Provide the patient with written information regarding fragility fractures and preventive measures that can be taken. Encourage them to speak with their primary care physicians for additional follow-up after the fracture has healed

Treatment

8. Physician Referral

A letter sent to the primary care physician can provide information regarding the patient’s fracture and recommend appropriate measures be taken

Treatment